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  • Shoulder - Impingement SYNDROME

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    YS Nate
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    This document discusses impingement syndrome, including its definition, anatomy, causes, symptoms, diagnosis, and treatment. Impingement syndrome is pain in the shoulder caused by structures in the subacromial space being impinged upon during arm elevation or internal rotation. It often results from repetitive overhead activities and is a common cause of rotator cuff tears over time. Diagnosis involves physical exam tests like Hawkins-Kennedy and Neer, along with imaging like x-rays, ultrasound, or MRI. Treatment begins with rest, NSAIDs, physiotherapy, and corticosteroid injections, with surgery such as acromioplasty as an option if conservative measures fail.

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    MSK

    Original Title

    Shoulder.impingement SYNDROME

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    This document discusses impingement syndrome, including its definition, anatomy, causes, symptoms, diagnosis, and treatment. Impingement syndrome is pain in the shoulder caused by structures in the subacromial space being impinged upon during arm elevation or internal rotation. It often results from repetitive overhead activities and is a common cause of rotator cuff tears over time. Diagnosis involves physical exam tests like Hawkins-Kennedy and Neer, along with imaging like x-rays, ultrasound, or MRI. Treatment begins with rest, NSAIDs, physiotherapy, and corticosteroid injections, with surgery such as acromioplasty as an option if conservative measures fail.

    Copyright:

    © All Rights Reserved
    Download as PPS, PDF, TXT or read online from Scribd
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    245 views14 pages

    Shoulder - Impingement SYNDROME

    Uploaded by

    YS Nate
    This document discusses impingement syndrome, including its definition, anatomy, causes, symptoms, diagnosis, and treatment. Impingement syndrome is pain in the shoulder caused by structures in the subacromial space being impinged upon during arm elevation or internal rotation. It often results from repetitive overhead activities and is a common cause of rotator cuff tears over time. Diagnosis involves physical exam tests like Hawkins-Kennedy and Neer, along with imaging like x-rays, ultrasound, or MRI. Treatment begins with rest, NSAIDs, physiotherapy, and corticosteroid injections, with surgery such as acromioplasty as an option if conservative measures fail.

    Copyright:

    © All Rights Reserved
    Download as PPS, PDF, TXT or read online from Scribd
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    Download as pps, pdf, or txt
    of 14

    Impingement Syndrome

    Learning Objectives

    What is?
    Why people get?
    Who gets?
    How does manifest ?
    How do we investigate ?
    How do we treat?

    Definition / Anatomy
    Etiology / Mech of injury
    Incidence
    Hystory / Physical exam
    Investigation
    Treatment

    What is ?

    Impingent syndrome describes


    pain in the subacromial space
    when the humerus is elevated or
    internally rotated

    Impingent syndrome is thought to


    precipitate structural changes in the
    Rotator Cuff leading to Rotator Cuff
    tears

    Definition

    What is ?
    Functionally Shoulder = 3 joints

    1. Scapulo thoracic joint


    2. Acromio-clavicular joint
    3. Gleno humeral joint

    Anatomy

    What is ?
    Anatomy
    The Gleno humeral joint , a ball-and-socket joint is stabilised
    by soft tissue

    AP view
    Lat view

    What is ?

    Anatomy

    Bursa located between the acromion and the rotator cuff


    tendons prttecting from grinding against each other

    Why people get ?

    Etiology Mech of injury

    Etiological theories
    1. Mechanical wear variations in shape of acromion
    2. Avascularity of supraspinatus tendon
    3. Trauma micro / macro

    I
    Acromion variations
    II

    Lat view

    AP view

    III

    Who gets it ?

    Incidence

    Impingement occurs to some degree in everyones shoulder on


    day-to-day basis
    Age : 40 50
    Physical activity : Labour / Sport / Trauma
    Jobs: painter, carpenter, truckdrivers ( overhead activities )
    Sports: swimming, tenis, baseball

    How does it manifest?


    Pain is the main complaint

    History
    Reaching the back pocket

    Ask for: - onset


    - duration
    - location
    - timing
    - quality of pain

    Age > 40

    Grey hair = Cuff tear

    Onset / Timining

    trauma / overuse / overhead / repetitive activities

    Sleep

    Pain at night / inability to sleep on affected side

    Weakness
    Catching & Crepitus

    How does it manifest ?

    Physical Exam

    Inspection

    - muscle atrophy / posture / position of scapula / deformities

    Palpation

    - systematic / orderly soft tissue & bony structures


    - tenderness greater tuberosity extension & internal rot
    Reaching the back pocket

    Range of movement
    painful arc = 60 120 degree

    How does manifest ?

    Impingement Tests

    2.
    1. Hawkins
    Neer testKennedy Test

    Physical Exam

    How do we investigate ?

    Investigation

    Radiography

    - osteophytes of the acromion


    - two views mandatory (5-10 caudal tilt)
    shape of acromion

    Ultrasound

    - preferable requires experience

    Shoulder Arthrogram - mainly for Rotator Cuff tears


    MRI

    - v. sensitive , expensive

    How do we treat?

    Treatment

    Non operative treatment

    Rest / Modification of activity


    NSAIDs acute phase
    Subacromial injection corticosteroid & local anasthetic
    Physiotherapy stretching / strenthening

    How do we treat ?

    Treatment

    Surgical Treatment
    Open : Anterior acromioplasty & coracoacromial lig resection
    Arthroscopic : Acromioplasty

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